Ukil Isildak Fatma, Yavuz Yasemin
Department of Anesthesia and Reanimation, Istanbul Provincial Health Directorate Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey.
Cardiol Young. 2022 Sep;32(9):1491-1497. doi: 10.1017/S1047951122001457. Epub 2022 May 2.
This study aimed to address the role of various inflammation-related blood indices for the assessment of in-hospital outcomes in subjects undergoing Glenn procedure. Subjects who underwent the Glenn procedure for hypoplastic left heart syndrome were analysed retrospectively. Subjects were divided into two groups: Group 1 consisted of 78 patients who were discharged, and Group 2 included 12 patients who died after surgery. Post-operative third-day neutrophil count and neutrophil-to-lymphocyte ratio value were significantly higher in the exitus group compared to the discharged group (p = 0.006 and p = 0.003, respectively). Third-day neutrophil-to-lymphocyte ratio was positively correlated with duration of intubation (r = 0.253, p = 0.018), length of stay in ICU (r = 0.296, p = 0.006) and length of hospital stay (r = 0.297, p = 0.005). Multiple logistic regression analysis revealed that patients with high third-day neutrophil-to-lymphocyte ratio (≥6) had 14.227-fold higher risk of death compared to those with lower values. In addition, higher pulmonary arterial pressure was associated with increased risk of death. Receiver operating characteristics analysis revealed that neutrophil-to-lymphocyte ratio had 66.67% sensitivity, 84% specificity, 81.61% accuracy, 40.00% positive predictive value and 94.03% negative predictive value with a cut-off point of ≥6 to predict mortality. Third-day neutrophil-to-lymphocyte ratio and increased post-operative pulmonary arterial pressure are significant predictors for in-hospital mortality in Glenn procedure recipients. A cut-off value of ≥6 for third-day neutrophil-to-lymphocyte ratio predicts mortality with 66.67% sensitivity and 84% specificity. Given its simplicity and availability, post-operative neutrophil-to-lymphocyte ratio should be monitored on a daily basis to identify patients with high risk for mortality after Glenn procedure.
本研究旨在探讨各种炎症相关血液指标在评估接受格林手术患者院内结局中的作用。对因左心发育不全综合征接受格林手术的患者进行回顾性分析。将患者分为两组：第1组包括78例出院患者，第2组包括12例术后死亡患者。与出院组相比，死亡组术后第3天的中性粒细胞计数和中性粒细胞与淋巴细胞比值显著更高（分别为p = 0.006和p = 0.003）。术后第3天的中性粒细胞与淋巴细胞比值与插管时间（r = 0.253，p = 0.018）、重症监护病房住院时间（r = 0.296，p = 0.006）和住院时间（r = 0.297，p = 0.005）呈正相关。多因素logistic回归分析显示，术后第3天中性粒细胞与淋巴细胞比值高（≥6）的患者死亡风险比比值低的患者高14.227倍。此外，较高的肺动脉压与死亡风险增加相关。受试者工作特征分析显示，中性粒细胞与淋巴细胞比值以≥6为临界值预测死亡率时，灵敏度为66.67%，特异度为84%，准确度为81.61%，阳性预测值为40.00%，阴性预测值为94.03%。术后第3天中性粒细胞与淋巴细胞比值及术后肺动脉压升高是格林手术患者院内死亡的重要预测因素。术后第3天中性粒细胞与淋巴细胞比值≥6的临界值预测死亡率的灵敏度为66.67%，特异度为84%。鉴于其简便性和可获得性，应每日监测术后中性粒细胞与淋巴细胞比值，以识别格林手术后死亡风险高的患者。
